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Abstract: TH-PO916

Factors Associated With Reduced Anti-SARS-CoV-2 Antibody Responses After mRNA Vaccination in Kidney Transplant Recipients on Belatacept

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)


  • Al Jurdi, Ayman, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Morena, Leela, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Azzi, Jamil R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Fishman, Jay A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Riella, Leonardo V., Massachusetts General Hospital, Boston, Massachusetts, United States

Antiviral antibody responses to SARS-CoV-2 vaccines are reduced in kidney transplant recipients (KTRs) on belatacept compared to those not on belatacept. However, factors associated with lower odds of developing antibody responses in KTRs on belatacept are not known.


We conducted a retrospective multicenter cohort study of all KTRs on belatacept who received three mRNA vaccine doses at our institutions, where all KTRs on belatacept had anti-SARS-CoV-2 receptor-binding domain (RBD) antibodies measured by the Roche Elecsys immunoassay. The primary outcome was development of anti-RBD antibodies after the third vaccination.


58 KTRs on belatacept were included. Median age was 62 and 69% were female. 78% were on prednisone, 60% on mycophenolate, 11% on mTOR inhibitors and 9% on azathioprine. After the third vaccine, 32/58 KTRs (55%) developed anti-RBD antibodies (Fig. 1A) with a median level of 3.3U/mL (Fig. 1B). Using univariate logistic regression, we found that age≥60, eGFR<45ml/min/1.73m2, prednisone use, and no prior SARS-CoV-2 infection were associated with significantly lower odds of developing anti-RBD responses after vaccination (Fig. 1C). These associations remained significant in the adjusted multivariable model (Fig. 1D). We also evaluated correlation between anti-RBD antibody levels and the number of days between vaccination and the most recent belatacept infusion for each vaccination but did not find an association between the two (Fig. 1E-G).


Prednisone use, age≥60, eGFR<45ml/min/1.73m2, and no history of SARS-CoV-2 infection are associated with lower odds of anti-RBD antibody responses after vaccination in KTRs on belatacept.